Provider Demographics
NPI:1831696897
Name:SANTIAGO, JENNIFER LEA (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 RUSH LIMA RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9004
Mailing Address - Country:US
Mailing Address - Phone:585-474-5317
Mailing Address - Fax:
Practice Address - Street 1:7016 RUSH LIMA RD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-9004
Practice Address - Country:US
Practice Address - Phone:585-474-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331737164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331737OtherNYSBON